Importance of recognizing pseudo-septal infarction due to electrocardiographic lead misplacement

Awareness of the problem of false electrocardiographic diagnosis of septal infarction due to cranially misplaced precordial leads V1 and V2, a common technical error, is important because this pseudo-pathologic finding can trigger unnecessary medical procedures and have other adverse sequelae. The non-trivial nature of this problem is emphasized by the case of a patient in whom the misdiagnosis caused loss of an employment opportunity. We demonstrate how P wave morphology in lead V2 can aid the clinician in suspecting erroneous right precordial lead placement in cases of apparent septal infarction. Ultimately, improved education of health care personnel regarding accurate precordial lead positioning technique is needed to minimize the occurrence of this electrocardiographic misdiagnosis.     

Impaired increase of retinal capillary blood flow to flicker light exposure in arterial hypertension

We hypothesized that the increase of retinal capillary blood flow (RCF) to flicker light exposure is impaired in subjects with arterial hypertension. In 146 nondiabetic untreated male subjects with (n=50) or without (n=96) arterial hypertension, RCF was measured before and after flicker light exposure noninvasively and in vivo using scanning laser Doppler flowmetry. In addition, in a subgroup of 28 subjects, the change of RCF to flicker light exposure was again assessed during parallel infusion of nitric oxide synthase inhibitor N-monomethyl-l-arginine (L-NMMA). The increase of RCF to flicker light exposure was lower in patients with untreated hypertension compared with normotensive subjects when expressed in absolute terms (7.69±54 versus 27.2±44 AU; P adjusted=0.013) or percent changes (2.95±14 versus 8.33±12%; P adjusted=0.023). Systolic (β=-0.216; P=0.023) but not diastolic blood pressure (β=-0.117; P=0.243) or mean arterial pressure (β=-0.178; P=0.073) was negatively related to the percent change of RCF to flicker light exposure, independently of other cardiovascular risk factors. In the subgroup of 28 subjects, the increase of RCF to flicker light exposure was similar at baseline and during parallel infusion of L-NMMA when expressed in absolute terms (20.0±51 versus 22.6±56 AU; P=0.731) or percent changes (7.12±16 versus 8.29±18%; P=0.607). The increase of RCF to flicker light exposure is impaired in arterial hypertension. In the subgroup of the total study cohort, nitric oxide was not a major determinant of the increase of RCF to flicker light exposure.